A disease that characteristically occurs in teenage girls, anorexia nervosa is like a sparrow
locked in a golden cage. Sparrow because the girls eat like a sparrow: literally savoring crumbs of
food for hours. Golden because their very condition becomes an object of pride - the skinnier the
better. Locked because there is no way out of their cage short of unlocking all the many locks they
have placed on their confinement. Behavior modification regimens produce weight gains that
evaporate as quickly as the regimentation is lifted.

The only successful approach seems to be Bruch's approach that involves directed
psychotherapy to unlock the idiosyncratic chains that bind her clients. First she has the girls gain
enough weight to be off the danger list, then she fosters their desire for independence from their
familial strictures. This complex of family expectations and stroke economies comprises the
primordial golden cage, one that was unconscious to both parents and children. As the girls grew
older, they found that to continue to be well-behaved by their parents definitions, they had to remain
a little girl, both physically and psychically. Thus they found in stringent dieting a process that
accomplished two important goals: it kept them little and gave them one thing over which they had
sole control. The side effects were pleasing also at first: they were slender. But nature requires
optima for health, not maxima or minima, and soon their weight hovers at a catastrophic minimum
that threatens their life. At this point even the most stubbornly resistant parents will recognize that
their own best intentions have endangered their daughter's life.

Bruch's therapeutic approach combines insight therapy for her anorexic patient with family
therapy for the confused parents and long term tracking of the recovering patient's progress. Like
Milton Erickson she sees that the defect is a developmental one: when the girl reaches menarche and
should begin dating boys, she retracts into a cage, and by losing weight pulls herself back from the
brink of adulthood. Menstruation stops, if it had begun, and she throws herself into physically
demanding activities, usually athletics, that garner her much praise and admiration, and provide a
convenient excuse for avoiding boys. An ingenious solution, one that the perpetrators are usually
surprised to find is not unique to themselves. When they discover in Bruch's therapy that many other girls have chosen
similar solutions to their developmental problems, they are ready to begin their journey into maturity.
With Bruch's help they must yet systematically remove each of the locks and bars of their golden
cage, but the changing of their attitude and that of their parents is a necessary precondition to
beginning the removal.

Any parent of teenage girls would do well to recognize the pitfalls of parenthood that Bruch
highlights as leading to the creation of an anorectic child. Anorexia is a slow, painful suicide - it is
far better to be avoided than treated.

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